Effects Of Different Pneumoperitoneum Methods On Early Cognitive Function After Laparoscopic Surgery In Middle-aged And Elderly Patients In High Altitude Areas

Objective:To investigate the effects of retroperitoneal approach and transabdominal approach on early postoperative cognitive function,intraoperative blood gas indexes and other postoperative complications in middle-aged and elderly patients undergoing laparoscopic surgery in high altitude areas.Methods:A total of 100 patients who underwent laparoscopic surgery in the affiliated Hospital of Qinghai University from December 2020 to December 2021 were divided into retroperitoneal group（R group）and transperitoneal group（T group）according to different modes of pneumoperitoneum.There were 50 cases in each group.The score of Montreal Cognitive Assessment scale（MoCA）was recorded 1 day before operation,1 day after operation and 3 days after operation.The incidence of early postoperative cognitive dysfunction（POCD）was compared.The time of operation and the dosage of general anesthesia were recorded.Heart rate（HR）,mean arterial pressure（MAP）,arterial blood p H value and arterial blood carbon dioxide partial pressure（PaCO₂）were recorded before anesthesia induction（T0）,30 minutes after pneumoperitoneum（T1）and before extubation（T2）.The score of numerical rating scale（NRS）about pain,the incidence of postoperative nausea and vomiting（PONV）were recorded at 1 day and 3 days after operation.And the number of Patient Controlled Analgesia（PCA）was recorded at 1 day and 2 days after operation.Results:（1）The baseline data of two groups such as age,educational level,comorbidities,and operation time was no significant difference（P>0.05）.（2）Comparison within the group,the MoCA score on the 1st day and 3rd day after the operation was significantly lower than that on the 1st day before the operation（P<0.05）;compared between the groups,there was no statistical difference in the MoCA score between the two groups at different times（P>0.05）;there was no significant difference in the incidence of POCD between the two groups at 1 day and 3 days after operation（P>0.05）.（3）There were no significant differences in HR and MAP between the two groups at different time points（P>0.05）;at T2,the p H value of the R group was significantly lower than that of the T group（P<0.05）;at T1 and T2,the PaCO₂ in the R group was significantly higher than that in the T group（P<0.05）.（4）The NRS score at 3 days after operation and the number of PCA at 2 days after operation in the R group were significantly higher than those of the T group（P<0.05）;on the 1st day after the operation,the occurrence of PONV in the T group was significantly higher than that in the R group（P<0.05）.Conclusion:（1）There was no significant difference in cognitive function changes in middle-aged and elderly patients with different laparoscopic surgical approaches at 1 day and 3 days after operation.（2）Compared with the previous data in plain areas,there was no significant difference in the occurrence of early POCD among permanent residents in high-altitude areas;and POCD occurs less frequently,but it is still recommended that patients undergoing day surgery avoid making major decisions in the early postoperative period.（3）The retroperitoneal approach is more prone to CO₂ accumulation,acidosis and postoperative pain,while the transperitoneal approach is more prone to PONV.